National Emergency Response Council on HIV/AIDS



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19 October 2021



…… Results of the Eswatini HIV Recent Infection Surveillance

There are three highly effective strategies to help prevent the sexual transmission of HIV, which when used consistently and correctly, lower the risk for sexual HIV transmission. These include consistent and correct condom use, consistent and correct use of antiretroviral treatment (ART) by people living with HIV to maintain an undetectable viral load, as well as consistent and correct use of oral pre-exposure prophylaxis (PrEP). Earlier on the focus was on correct and consistent condom use as an HIV prevention measure.


The subject was provoked by a recent study  conducted by the Ministry of Health which identified at least 10 constituencies country-wide where a disturbing rise in new HIV infections have been noted, with 5 of the constituencies being under the Hhohho region.

The constituencies under Hhohho are Lobamba, Mbabane West, Mbabane East, Madlangemphisi and Motshane. The Eswatini HIV Recent Infection Surveillance was undertaken by Eswatini National AIDS Program (ENAP) under the Ministry of Health. In early September, Hhohho HIV Implementers met to discuss the emerging HIV infections in the region.

The meeting was attended by a wide range of stakeholders, including the Ministry of Health and NERCHA research office. Conspicuous in the presentation made by MoH on the recency data is the high number of HIV infections seen in the age groups (20-24 & 25-29), with many of them reporting to have experienced gender-based violence and others citing inconsistent condom use. The exercise also sought to investigate existing behavior patterns and livelihoods in these affected constituencies, establish how partners target and deliver services in communities as well as highlight communities that do not receive full National Minimum Package (NMP) coverage. This week we address the issue of rise in new HIV infections by taking a closer look at the second highly effective strategy to prevent sexual transmission of HIV, and that is correct and consistent use of Anti-retroviral Treatment (ART) by People living with HIV.



  • Taking antiretroviral treatment (ART) reduces the amount of HIV in your body.
  • With proper adherence, ART can reduce HIV to such low levels that the virus can no longer be detected in normal blood tests. This is called having an ‘undetectable’ viral load.  
  • People with undetectable viral loads can’t pass HIV on through sex.
  • To know that you’re undetectable, you must have your viral load monitored regularly. 
  • Remember your viral load can change. If you stop taking your treatment properly your viral load will go up again.

What is an undetectable viral load?

An undetectable viral load  is where antiretroviral treatment (ART) has reduced your HIV to such small quantities that it can no longer be detected by standard blood tests. People living with HIV who have an undetectable viral load cannot pass HIV on through sex.

Being undetectable does not mean your HIV is cured. There is still HIV in your body, although it has been reduced to very small amounts. This means that if you stop taking treatment, your viral load will increase – affecting your health and making HIV transmittable again.


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What will being undetectable mean for me?

Having an undetectable viral load means that your ART is effectively controlling your HIV. This will protect your immune system and help you to stay in good health.

Being undetectable also means that you don’t have to worry about passing HIV onto your sexual partners. For many people this is just as important to them, giving them relief from the anxiety of passing HIV on. Some people find that knowing they’re undetectable makes it easier to share their HIV status with others, as it can be reassuring for others to know that your health is protected and you can’t pass it on too.

Can my viral load continue to change?


Yes, your viral load can continue to change. This would usually be a result of factors to do with your adherence (whether you are taking your pills at the right times and in the right way), or other health issues. Regular viral load monitoring will help you stay on top of these changes, so you can manage your health accordingly.

Your viral load usually drops quickly after first starting treatment, however it may be a while before it reaches a point where it’s undetectable. Most people who adhere properly to their treatment become undetectable after about six months, but it’s important that you have a viral load test to confirm this.

While changes to viral load can occur, they should be relatively uncommon for people who adhere properly to their medication and are otherwise in good health. Your viral load monitoring appointments are there to help you to identify and respond to any changes in your viral load.

These appointments also give you time to discuss any difficulties you are having with your medication. Often big life changes, like starting a new relationship or moving to a new place, can make adherence more difficult. Your healthcare worker can help you with any new challenges and work with you to stay healthy and keep your viral load low.

Can everyone living with HIV achieve an undetectable viral load?

Although being virally suppressed and undetectable is the aim of HIV treatment for everyone, there are some reasons why a person may not be able to achieve an undetectable viral load. These can include factors outside of someone’s control, for example:

  • Drug interactions
  • Side effects
  • Adherence challenges
  • Other health issues

For some people, it might be tricky to find a treatment regime that agrees with them. While in some places, viral load testing may not always be readily available.

If this is the case for you, it’s essential that you still take your medication exactly as prescribed and that you keep regular appointments with your healthcare team. While you may not be ‘undetectable’, you can still remain healthy and your healthcare workers will still work with you to help you have the best treatment outcomes possible.

Does being undetectable mean you can’t pass HIV on through pregnancy, breastfeeding or sharing injecting equipment?

At the moment we cannot say that there is zero risk of transmitting HIV through pregnancy, breastfeeding or sharing injecting equipment for people with undetectable viral loads. The evidence we have for U=U only applies to sexual transmission at this time.

Although we know that having an undetectable viral load will radically reduce the risk of passing HIV on by any route, it’s likely that for injecting drugs and breastfeeding the risk will not be zero.

Nevertheless, many women without access to clean water and affordable formula feed are still advised to breastfeed. For their babies breastfeeding is still the safest option to avoid the more dangerous risks of diarrhoeal disease and malnutrition. So long as they adhere to their medication the risk of HIV transmission will be very low.

If you are unsure what the advice is for you or have any concerns about HIV transmission, you should speak to your doctor or healthcare worker.